Usefulness of preprocedural 3-dimensional computed tomography planning in assisting one-stage pulmonary veins isolation with concomitant left atrial appendage occlusion procedure: A pilot study

Figures

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  Fig. 1. Interactive Preprocedural 3D Computed Tomography (CT) Planning. Using CT data for 3D modeling, we employed an interactive central line algorithm to analyze the central axis from the fossa ovalis puncture point to the tip of the left atrial appendage (LAA), automatically capturing the anatomical data of the LAA ostium. In the 'output' diagram, the red dashed line indicates the actual shape of the LAA ostium, the light-yellow circle represents a hypothetical circle with the same area as the LAA ostium, and the orange circle represents a hypothetical circle with the same circumference as the LAA. Based on this analysis, the area-derived diameter, perimeter-derived diameter, depth, and recommended implant size were determined for the preprocedural planning. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 2. Representative case of radiofrequency ablation with concomitant LAAO In this representative case, we first performed an atrial septal puncture, followed by pulmonary vein isolation (PVi) using 3D mapping-guided radiofrequency ablation (A). This is followed by left atrial appendage (LAA) angiography (B) and implantation of an LAA occluder (C). Preprocedural CT planning images display various angles and automatically highlight the LAA (D). For comparison, intra-procedural transesophageal echocardiography (TEE) was performed (E). Analysis of the LAA ostium automatically calculated key anatomical data and provided recommendations for a suitable implant size (F).

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  Fig. 3. Representative case of cryoballoon ablation with concomitant LAAO In this representative case, we first performed an atrial septal puncture and pulmonary vein isolation (PVi) using a cryoballoon (A), followed by LAA angiography (B), and then implanted a left atrial appendage occluder (C). Preprocedural CT planning images display various angles and automatically highlight the LAA (D). For comparison, an intra-procedural transesophageal echocardiography (TEE) is shown in (E). Analysis of the LAA ostium automatically calculates key anatomical data and provides recommendations for suitable implant size (F).

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  Fig. 4. Comparison of different imaging modalities. (A) Comparison of different imaging modalities with the actual size of the implanted occluder. The analysis shows that the LAA ostium diameter (perimeter-derived diameter) obtained using the 3D CT algorithm is more accurate and closer to the actual occluder size than the diameters obtained by TEE or angiography. (B) Compression rates were determined by various imaging modalities, highlighting that 3D CT provides a more precise compression rate. Abbreviations: 3D CT, 3D Computed Tomography; TEE, transesophageal echocardiography.